Colored suture

ABSTRACT

Suture containing filaments of ultra-high molecular weight polyethylene (UHMwPE), characterized in that the suture contains a multi-filament yarn that is obtained by a process comprising the steps of: a) Providing a mixture containing UHMwPE, a spinning solvent and a pigment b) Spinning a multi-filament yarn from the mixture by the gel spinning process.

This application is the U.S. national phase of International ApplicationNo. PCT/EP2008/004135, filed 23 May 2008, which designated the U.S. andclaims priority to European Application No. 07010217.3, filed 23 May2007, the entire contents of each of which are hereby incorporated byreference.

The invention relates to a colored suture. The coloring of sutures isfor example used to make the suture better contrast with the blood ortissue in the operating area. In complicated surgical operations, forexample in arthroscopic surgery, when different suture ends are used ina small area, sutures of different color are used to assist surgeons indiffering between the suture ends. It is also possible for this reasonto combine filaments of different colors in a suture in a certainpattern, to aid surgeons in identifying the travel direction of thesuture during surgery, particularly during arthroscopic operations.

Next to coloring is also suture strength an important consideration inselecting filaments for producing a suture. Very strong filaments, atpresent available for the production of sutures, are filaments ofultra-high molecular weight polyethylene (UHMwPE), produced according tothe gel spinning process.

A problem of such filaments is that they are difficult to color. Due tothe a-polar character of the UHMwPE a colorant like a dye or a coloredcoating material adheres poorly to the surface of the filament. Ifadhesion is insufficient the filaments may loose part or all of thecolorant because of the handling during production of the sutures, ormay loose part of the colorant in place in the human or animal body,which is undesired because of negative effects on the health. Attemptshave been made to enhance the adhesion of colorants to the filaments bygiving the filaments a pre-treatment, for example a plasma treatment.Such pre-treatments in general however have an adverse effect on themechanical properties of the filaments, like for instance the tensilestrength and often don't improve adhesion enough to make the filamentssuitable to be used in sutures.

In another attempt filaments of UHMwPE were dyed using super criticalcarbon dioxide as a solvent for the dye, as disclosed in EP-A-0 873 445.In this case the dye penetrated in the body of the filament, so thatadhesion problems did no longer play a role. However such a dye shows atendency to leach out, which is unfavorable for application of thefilaments in sutures. Also in U.S. Pat. No. 5,613,987 it was proposed touse a dye to color the UHMwPE filaments. Here the same problems occur.

Polyolefinic filaments, of which polypropylene filaments are the bestexample, are often colored by the incorporation of a pigment in thepolymer composition of the filaments during extrusion of the filaments.In Prog. Polym. Sci. 27 (2002) 853-913 the process for pigmentation ofpolypropylene filaments is described. The pigments are in a first stepuniformly dispersed in a so-called carrier polymer to obtain aconcentrated pre-mixture. In order to obtain a sufficient dispersion ofthe pigment the wetting of the pigment particles must be enhanced by theuse of a low viscous carrier polymer and dispersants. A low viscouscarrier polymer has a negative influence on mechanical properties of theUHMwPE filaments. Furthermore such filaments have a very low diametercompared to the diameter of polypropylene filaments, so thatun-dispersed or re-agglomerated clumps of pigment particles will have adetrimental effect on the tensile strength of the filaments. Thereforeit is disadvised in U.S. Pat. No. 5,613,987 to use pigments in UHMwPEfilaments. Also the use of dispersants in filaments that are used insutures is disadvantages, because such filaments must be biocompatibleand dispersants have a negative effect on that.

One solution proposed to overcome the problems of the coloring offilaments of UHMwPE is to combine the filaments in a suture withfilaments of a different polymer, preferably nylon, as disclosed in U.S.Pat. No. 7,029,490. Such sutures however have a complicated structureand the nylon filaments only contribute to the strength of the suture ata lower level compared to the filaments of UHMwPE.

Object of the invention is to provide a colored suture, which suturedoes not show the problems described above.

Surprisingly such a suture is obtained if the suture contains amulti-filament yarn that is obtained by a process comprising the stepsof:

a) Providing a mixture containing UHMwPE, a spinning solvent and apigment

b) Spinning a multi-filament yarn from the mixture by the gel spinningprocess.

The preparation of filaments of ultra high molecular weight polyethylene(UHMWPE) filaments, prepared by a gel spinning process, is for exampledescribed in EP 0205960 A, EP 0213208 A1, U.S. Pat. No. 4,413,110, GB2042414 A, EP 0200547 B1, EP 0472114 B1, WO 01/73173 A1, and AdvancedFiber Spinning Technology, Ed. T. Nakajima, Woodhead Publ. Ltd (1994),ISBN 1-855-73182-7, and references cited therein. Gel spinning isunderstood to include at least the steps of spinning filaments from asolution of ultra-high molecular weight polyethylene in a spin solvent;cooling the filament obtained to form a gel filament; removing at leastpartly the spin solvent from the gel filament; and drawing the filamentin at least one drawing step before, during or after removing spinsolvent. Suitable spin solvents include for example paraffin's, mineraloil, kerosene or decalin. Spin solvent can be removed by evaporation, byextraction, or by a combination of evaporation and extraction routes.Such filaments are commercially available as Spectra® or Dyneema®grades.

Good results are obtained if the UHMWPE has an intrinsic viscosity (IV,as determined according to method PTC-179 (Hercules Inc. Rev. Apr. 29,1982) at 135° C. in decalin, with dissolution time of 16 hours, withanti-oxidant DBPC in an amount of 2 g/l solution, and the viscosity atdifferent concentrations extrapolated to zero concentration) of above 5dl/g. Particularly suitable is UHMWPE with IV of between about 8 and 40dl/g, more preferably between 10 and 30, even more preferably between 12and 28, most preferably between 15 and 25 dl/g. These ranges representan optimum in polymer processability and filament properties. Intrinsicviscosity is a measure for molar mass (also called molecular weight)that can more easily be determined than actual molar mass parameterslike M_(n) and M_(w). There are several empirical relations between IVand M_(w), but such relation is highly dependent on molar massdistribution. Based on the equation M_(w)=5.37×10⁴ [IV]^(1.37) (see EP0504954 A1) an IV of 8 dl/g would be equivalent to Mw of about 930kg/mol.

Preferably, the UHMWPE is a linear polyethylene with less than onebranch per 100 carbon atoms, and preferably less than one side chain per300 carbon atoms, a branch usually containing at least 10 carbon atoms.The linear polyethylene may further contain up to 5 mol % of one or morecomonomers, such as alkenes like propylene, butene, pentene,4-methylpentene or octene.

In a preferred embodiment, the UHMWPE contains a small amount ofrelatively small groups as side chains, preferably a C1-C4 alkyl group.It is found that a filament from UHMWPE with a certain amount of suchgroups show reduced creep behaviour. Too large a side chain, or too highan amount of side chains, however, negatively affects the processing andespecially the drawing behaviour of the filaments. For this reason, theUHMWPE preferably contains methyl or ethyl side chains, more preferablymethyl side chains. The UHMWPE therefore contains preferably at least0.2, more preferably at least, still more preferably at least 0.3, stillmore preferably at least 0.4, most preferably at least 0.5 methyl orethyl side chains. The amount of side chains is preferably at most 20,more preferably at most 10 per 1000 carbon atoms.

The UHMwPE can be a single polymer grade, but also a mixture of two ormore different grades, e.g. differing in IV or molar mass distribution,and/or number of side chains. Preferably the polymeric part of thefilaments is a single grade UHMwPE.

The number of filaments in the multi-filament yarn may be between 10 and1000. Preferably the number of filaments in the multi-filament yarn ismore than 20, more preferably more than 30.

The mixture containing the UHMwPE, the spinning solvent and the pigmentmay be provided at different stages in the gel spinning process. It isfor example possible to produce in a first step a dry mixture of UHMwPEpowder and the pigment, to produce in a second step a slurry of thatmixture in a spinning solvent, to dissolve the UHMwPE in the spinningsolvent in a third step to obtain a slurry of the pigment in a solutionof UHMwPE in the spinning solvent and to spin the multi-filament yarnfrom that solution. It is also possible to produce a solution of UHMwPEin the spinning solvent first and to add the pigment to that solution.

The UHMwPE filaments preferably contain less than 800 ppm of residualamounts of spin solvent, more preferably less than 500, even morepreferably less than 250, most preferably less than 100 ppm; such asless than 80 ppm, or less than 60 ppm. Filaments and suture with lowresidual amount of spin solvent is highly advantageous in being moresuitable for implantation.

Suitable pigments include organic and inorganic pigments. Examples oforganic pigments include azo-pigments and phtalo-pigments. Good resultsare obtained with C.I. Vat brown I and C.I. Solvent Yellow 18. Examplesof inorganic pigments include pigments containing titanium dioxide, ironoxides and chromium oxides. Good results are obtained withaluminium-chromium-cobalt oxide, since a suture with good mechanicalproperties and a low degree of leaching out is obtained.

The amount of pigment used may be between 0.1-7 wt. % of the finalfilament, as used for the production of the suture. Preferably the finalfilament contains at least 0.3 wt. %, more preferably at least 0.5 wt. %even more preferably at least 0.7 wt. % of pigment. Preferably the finalfilament contains at most 5.0 wt. %, more preferably at most 3 wt. % ofpigment, even more preferably at least 2.5 wt. %, most preferably atmost 2 wt. %. This is in view of obtaining a bright colour and goodmechanical properties.

The UHMwPE filaments in the suture according to the invention consistpreferably of UHMwPE, the pigment and less than 1000 ppm of furtherconstituents, preferably less than 500 ppm of further constituents, morepreferably less than 200 ppm of further constituents, most preferablyless than 100 ppm of further constituents, such as less than 80 ppm, orless than 60 ppm.

A suitable size for the suture according to the invention may be in thefull USP range for sutures (e.g. 12-0 to 10). A USP value of 10corresponds with a maximum diameter of 1.3 mm. In one preferredembodiment the suture member has a titer of between 25 and 500 dtex. Inthat case the suture is very suitable for cardiovascular operations. Inanother preferred embodiment the suture has a titer of between 500 and3000 dtex. In that case the suture is very suitable for use inorthopedic applications. In yet another preferred embodiment the suturehas a titer of between 3000 and 9000 dtex. In that case the suture isvery suitable to be used in heavy orthopedic applications.

The suture may in addition to the ultra high molecular polyolefinfilaments comprise further components, for example compounds thatprovide some functional effect, like anti-microbial or anti-inflammatoryaction, or that further improve knotting performance. The amount of suchother components is generally limited to at most 20 mass % (relative tototal cable mass), preferably at most 10, more preferably at most 5 mass%.

The suture according to the invention comprises preferably at least 50mass % of the ultra high molecular weight polyolefin filaments. Theultra high molecular weight polyolefin filaments contribute most to thestrength properties of the member. Furthermore the filaments enhance thesliding properties of the suture through tissue. Therefore morepreferably the suture comprises at least 60 mass % of the ultra highmolecular weight polyolefin filaments, more preferably at least 70, 80or at least 90 mass %. The suture may further comprise other fibres,e.g. other biocompatible materials like polymers, to provide some otheradditional properties to the suture, including improved knot slipbehaviour or visual contrast. Such other fibres may be present in theform of one or more strands in the suture. However, preferably eachstrand has the same composition, so that each strand comprises the sameamount of the polyolefin filaments and of the other filaments. Thisensures that the suture has a homogeneous structure.

Suitable examples of other fibrous materials include filaments or staplefibres made from non-absorbable polymers like other polyolefin's,fluoro-polymers, or semi-aromatic polyesters like polyethyleneterephthalate, absorbable polymers like aliphatic polyesters based one.g. lactides.

Most preferably the suture consists of the polyolefin filaments. Theinvention also relates to the use of the suture according to theinvention in surgical method.

The invention is further explained in the examples, without beinglimited to the examples.

Methods

Intrinsic Viscosity.

The Intrinsic Viscosity (IV) is determined according to method PTC-179(Hercules Inc. Rev. Apr. 29, 1982) at 135° C. in decalin, thedissolution time being 16 hours, with DBPC as anti-oxidant in an amountof 2 g/l solution, by extrapolating the viscosity as measured atdifferent concentrations to zero concentration;

Tensile Properties.

Tensile properties: tenacity, tensile modulus (or modulus) andelongation at break (or eab) are defined and determined on multifilamentyarns with a procedure in accordance with ASTM D885M, using a nominalgauge length of the fibre of 500 mm, a crosshead speed of 50%/min andInstron 2714 clamps, of type Fibre Grip D5618C. On the basis of themeasured stress-strain curve the modulus is determined as the gradientbetween 0.3 and 1% strain. For calculation of the modulus and strength,the tensile forces measured are divided by the titre, as determined byweighing 10 meters of fibre; values in GPa are calculated assuming adensity of 0.97 g/cm³;

Leaching Tests

According to the requirements of ISO 10993-12:2002(E) an extraction wasperformed with samples of multi-filament yarn in both polar (distilledwater) and non-polar (cottonseed oil) solvents. The extractionconditions were 37° C. for 24 and 72 hours.

After dilution with acetonitrile, the different phases were analyzed onthe presence of pigment using Liquid Chromatography-Mass Spectrometry(LC-MS) and Gas Chromatography-Mass Spectrometry (GC-MS). In case noleaching I was observed means that leaching was lower than 10 ppb.Cytotoxicity.

Cytotoxicity tests were performed according to ISO 10993-5, 1999:Biological Evaluation of Medical Devices—Part 5: Tests for in vitrocytotoxicity. The biological reactivity of a mammalian monolayer, L929mouse fibroblast cell culture, in response to the test item extracts(samples containing up to 2.0 wt. % pigment) was determined. Extractswere prepared at 37° C. (±1) for 24 hours in a humidified atmospherecontaining 5±1% CO₂. Positive (natural rubber) and negative (silicone)control articles were prepared to verify the proper functioning of thetest system. The maintenance medium of the cell cultures was replaced bythe extracts of the tests item or control article in triplicate and thecultures incubated for 48 hours, at 37° C. (±1). Biological reactivitywas rated on the following scale:

grade 0 (no reactivity)

grade 1 (slight reactivity)

grade 2 (mild reactivity)

grade 3 (moderate reactivity)

grade 4 (severe reactivity)

EXAMPLES 1-4

Slurries containing decalin, 6 mass % of powder of UHMwPE having an IVof 14 and 0.5, 1, 1.5 respectively 2 wt. % of aluminum-chromium-cobaltoxide pigment (of the cations is 32.5% Co, 32% Al and 35.5 Cr) wereprepared in a mixer.

The slurries were fed to a twin screw extruder having a diameter of 25mm, being equipped with a gear-pump at a temperature setting of 180° C.In the extruder the UHMwPE was dissolved in the decalin and the soobtained mixture of the UHMwPE dissolved in the decalin and the pigmentwas extruded through a spin plate having 24 spin holes into a nitrogenatmosphere with a rate of 1.0 g/min per hole. The so obtained solutionfilaments were cooled in a water bath kept at about 35° C. and with awater flow rate of about 5 cm/s perpendicular to the filaments enteringthe bath, and taken-up at such rate that a draw ratio of 15 was appliedto the as-spun filaments in the air-gap of 15 mm. The filamentssubsequently entered an oven at 130° C. The filaments were furtherstretched, during which process the decalin evaporated from thefilaments. After the stretching process the filaments were kept taut inan oxygen free environment for 24 hours at 100° C.

Mechanical properties, leaching out and cytotoxicity were determined onthe so obtained multi-filament yarns.

The mechanical properties are reported in table 1. Favourable mechanicalproperties were obtained.

No compounds related to pigment, or other unknown compounds, wherefound. The pigment <10 μg/kg (<10 ppb).

From these results it can be concluded that the bio-availability ofpigment due to leaching from sutures according to the inventioncontaining the multi-filament yarn is negligible.

All the extracts of the colored samples when submitted to thecytotoxicity test exhibited no reactivity (grade 0) by the cellcultures. Severe reactivity (grade 4) was observed for the positivecontrol article. The negative control article showed no signs ofreactivity (grade 0). Therefore it can be concluded that suturesaccording to the invention containing the multi-filament yarn arenon-cytotoxic.

The yarns furthermore show a homogeneous and bright colour.

Comparative Test A.

Multi-filament yarn was produced according to examples 1-4, however nopigment was used.

The multi-filament yarn was dyed with D&C blue No 6 (delivered by SigmaAldrich of the USA) by placing the multi-filament yarn for 7 hours at120° C. in a solution of the dye in super-critical carbon dioxide.

The resulting yarns presented a non-homogeneous color distributionpattern.

Mechanical properties and leaching out were determined.

Mechanical properties are reported in table 1. A serious decline inmechanical properties was observed (tenacity decreased about 40%).

Considerable leaching out took place in coconut oil as was already clearfrom the disappearing color of the multi-filament yarn.

From these results it is clear that sutures containing themulti-filament yarn according to comparative test A are not suitable foruse in surgery.

Comparative Test B.

Multi-filament yarn was produced according to examples 1-4, however nopigment was used.

The multi-filament yarn was dip-coated with a polyurethane coatingcontaining an azo-dye (Sudan Red D, delivered by Sigma Aldrich).

Test data of the multi-filament yarn were measured and reported in tableI. It is clear that considerable leaching out took place and that thecyto-toxicity of the filaments is insufficient. Therefore suturescontaining the multi-filament yarn according to comparative test B arenot suitable for use in surgery.

TABLE 1 Example/ Tenacity Modulus Eab Xomp. exp. [cN/dTex] [cN/dTex] [%]leaching [—] cytotox. [—] colouring [—] I 37 1439 2.8 No 0 homogeneousII 37 1377 2.9 No 0 Homogeneous III 40 1501 3.0 No 0 Homogeneous IV 371414 2.9 No 0 Homogeneous A 21 — — Yes — Inhomogeneous B 37 1381 2.8 Yes— Inhomogeneous

The invention claimed is:
 1. A colored suture consisting ofmulti-filamentary yarn and at most 20 mass % of other components,wherein at least 50 mass % of the yarn consists of colored gel-spunfilaments obtained by spinning a mixture containing ultra-high molecularweight polyethylene (UHMwPE) having an intrinsic viscosity (IV) ofbetween about 8 and 40 dl/g, a spin solvent and a pigment, wherein thecolored filaments consists of UHMwPE, between 0.1 and 7.0 wt. % of aninorganic chromium oxide-containing pigment, a residual amount of lessthan about 100 ppm of the spin solvent, and less than 1000 ppm offurther constituents.
 2. The colored suture according to claim 1,wherein the amount of the inorganic pigment present in the filaments ofthe suture is between 0.3 wt. % and 5.0 wt. %.
 3. The colored sutureaccording to claim 1 or 2, wherein the amount of the inorganic pigmentpresent in the filaments of the suture is lower than 2.0 wt. %.
 4. Thecolored suture according to claim 1, wherein the inorganic pigment isaluminum-chromium-cobalt oxide.
 5. The colored suture according to claim1, wherein the filaments contain a residual amount of less than 60 ppmof the spin solvent.
 6. The colored suture according to claim 1, whereinthe filaments contain less than 500 ppm of further constituents.
 7. Thecolored suture according to claim 1, wherein the filaments contain lessthan 200 ppm of further constituents.
 8. The colored suture according toclaim 1, wherein at least 60 mass % of the yarn consists of saidgel-spun filaments.
 9. The colored suture according to claim 1, whereinat least 90 mass % of the yarn consists of said gel-spun filaments. 10.The colored suture according to claim 1, wherein the suture consists ofthe at least one multi-filamentary yarn and at most 10 mass % of othercomponents.
 11. The colored suture according to claim 1, wherein thesuture consists of the at least one multi-filamentary yarn and at most 5mass % of other components.
 12. The colored suture according to claim 1,wherein the suture consists of said gel-spun filaments.